Frailty predicts major bleeding within 30 days in elderly patients with Acute Coronary Syndrome

Salinas, Gonzalo Luis Alonso; Fernández, Marcelo Sanmartín; Izco, Marina Pascual; Castillo, A Marco Del; Rincón, Luis Miguel; Granero, Cristina Lozano; Gómez, Mónica; Pueyo, Pablo Pastor; Martin, David; Sanz, Ana Pardo; Ruiz, Juan Manuel Monteagudo; Recio-Mayoral, Alejandro; Ramos, Luis Salvador; Martín, Domingo Marzal; López, Ana M.; Mena, Manuel Jiménez; Gómez, José Luis Zamorano

doi:10.1016/j.ijcard.2016.07.268

Cited by 54 publications

(35 citation statements)

References 22 publications

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“…This finding is most likely explained by a relatively low event rate in our study. Although it would seem clear from a hypothetical viewpoint that more vulnerable elderly patients are more prone to bleeding complications, there have been no clear data from prospective studies that prove this concept [21, 22]. …”

Section: Discussionmentioning

confidence: 99%

The Role of Frailty in Acute Coronary Syndromes in the Elderly

et al. 2018

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Background: Myocardial infarction (MI) patients are increasingly older, and common risk scores include chronological age, but do not consider chronic comorbidity or biological age. Frailty status reflects these variables and may be independently correlated with prognosis in this setting. Objective: This study investigated the impact of frailty on the prognosis of elderly patients admitted due to MI. Methods: This prospective and observational study included patients ≥75 years admitted to three tertiary hospitals in Spain due to MI. Frailty assessment was performed at admission using the Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the composite of death or non-fatal reinfarction during a follow-up of 1 year. Overall mortality, reinfarction, the composite of death, reinfarction and stroke, major bleeding, and readmission rates were also explored. Results: A total of 285 patients were enrolled. Frail patients (109, 38.2%) were older, with a higher score in the Charlson Comorbidity Index and with a higher risk score addressed in the GRACE and CRUSADE indexes. On multivariate analysis including GRACE, CRUSADE, maximum creatinine level, culprit lesion revascularization, complete revascularization, and dual antiplatelet therapy at discharge, frailty was an independent predictor of the composite of death and reinfarction (2.81, 95% CI 1.16–6.78) and overall mortality (3.07, 95% CI 1.35–6.98). Conclusion: Frailty is an independent prognostic marker of the composite of mortality and reinfarction and of overall mortality in patients aged ≥75 years admitted due to MI.

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Section: Discussionmentioning

confidence: 99%

The Role of Frailty in Acute Coronary Syndromes in the Elderly

et al. 2018

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“…It is found in approximately half of the patients undergoing TAVI 45. In frail individuals, fibrin generation is reduced46 and the risk of major bleeding is increased independently of age 47. Anticoagulation is often avoided given the perceived fall risk that has been associated with bone fractures, bleeding events and mortality 48.…”

Section: Bleeding Riskmentioning

confidence: 99%

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Nijenhuis

Brouwer

Søndergaard

et al. 2019

Heart

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This review provides a comprehensive overview of the available data on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). In the absence of large randomised clinical trials, clinical practice is leaning towards evidence reported in other populations. Due to the greater risk of major bleeding associated with oral anticoagulation using a vitamin-K antagonist (VKA), antiplatelet therapy (APT) may be considered as the first-line treatment of patients undergoing TAVI. Overall, single rather than dual APT is preferred. However, dual APT should be considered in patients with a recent acute coronary syndrome (ie, within 6 months), complex coronary stenting, large aortic arch atheromas or previous non-cardioembolic stroke. Monotherapy with VKA should be considered if concomitant atrial fibrillation or any other indication for long-term oral anticoagulation is present. APT on top of VKA seems only reasonable in patients with recent acute coronary syndrome, extensive or recent coronary stenting or large aortic arch atheromas. A direct-acting oral anticoagulant may be considered if oral anticoagulation is indicated in the absence of contraindications. Initiation of VKA is indicated in clinical valve thrombosis, for example, with high transvalvular gradient, whereas the role of VKA in the case of subclinical leaflet thrombosis is currently uncertain.

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“…An equal benefit of clopidogrel was observed in young and elderly patients (≤65 vs >65 years). Recently, an observational study including 190 patients aged ≥75 years admitted for MI identified frailty as an independent predictor of major bleeding [4]. Therefore, in addition to patients who cannot receive ticagrelor or prasugrel, we advise to also treat the frail elderly patients with clopidogrel.…”

Section: Step Three: Antiplatelet Therapymentioning

confidence: 99%

“…They comprise a rapidly increasing subgroup of patients with an acute coronary syndrome (ACS) of which non-ST-segment-elevation ACS (NSTE-ACS) is the most common form [1]. Compared with younger patients, elderly patients with ACS are at higher risk of both atherothrombotic events and bleeding, due to frailty and comorbidities such as renal failure [2–4]. These higher risks require a different treatment.…”

Section: Introductionmentioning

confidence: 99%

Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome

Gimbel

Berg

2017

Neth Heart J

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Elderly patients with an acute coronary syndrome are underrepresented in randomised controlled trials. Neither the European Society of Cardiology nor the American Heart Association/American College of Cardiology acute coronary syndrome guidelines provide specific recommendations for elderly patients. However, elderly patients are at higher thrombotic and bleeding risk compared with younger patients leading to difficulties in choosing the optimal treatment. In this review, we discuss the uncertainties we encounter in treating elderly patients with non-ST-elevation acute coronary syndrome and suggest treatment options based on the existing literature.

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Frailty predicts major bleeding within 30 days in elderly patients with Acute Coronary Syndrome

Cited by 54 publications

References 22 publications

The Role of Frailty in Acute Coronary Syndromes in the Elderly

The Role of Frailty in Acute Coronary Syndromes in the Elderly

Antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome

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